苗健美 刘华平

[摘要] 目的 前瞻性觀察妊娠期糖尿病（GDM）患者孕期母体成分变化及其特点，探讨其与孕期血糖变化的相关性。 方法 随机选取2014年12月～2015年7月于中国人民解放军空军总医院建档的GDM孕妇77例及正常孕妇79例为研究对象，分别设为GDM组与对照组。监测两组在建档时（孕11～13周）、孕17～20周、孕24～28周、孕32～36周的基础代谢率、去脂体重、瘦体重、总体水、体脂含量、体脂百分比、细胞内水、细胞外水等体成分指标；记录建档时空腹血糖、孕24周的口服葡萄糖耐量试验（OGTT）结果；分析两组孕妇在不同孕期各体成分变化特点并探究其与孕期血糖变化的相关性。 结果 GDM孕妇在建档时、孕17～20周、孕24～28周体成分指标均高于对照组（P < 0.05或P < 0. 01），但孕32～36周时两组的体成分比较差异无统计学意义（P > 0.05）。建档时空腹血糖与建档时的基础代谢率、体脂含量、体脂百分比呈明显正相关（r = 0.217、0.255、0.244，均P < 0.01）；GDM组患者孕24周OGTT的服糖前血糖水平与建档时的体脂含量、体脂百分比呈明显正相关（r = 0.237、0.239，均P < 0.01），而服糖后1 h血糖则与孕17～20周的体脂含量、体脂百分比呈明显正相关（r = 0.302、0.288，均P < 0.01）。 结论 GDM孕妇孕期体成分指标明显高于正常孕妇，孕期体脂增加与孕期血糖变化相关，孕期体成分变化可能与GDM的发生存在一定关系。

[关键词] 妊娠期糖尿病；体成分；生物电阻抗

[中图分类号] R714.256 [文献标识码] A [文章编号] 1673-7210（2016）03（c）-0038-05

[Abstract] Objective To observe the variation and characteristic about matemal body composition of the pregnant women with gestational diabetes mellitus （GDM） in prospective study， investigate the relationship with glycemic excursion during pregnacy. Methods 77 GDM patients and 79 healthy pregnant from December 2014 to July 2015 in Air Force General Hospital were randomly selected， and set as the GDM group and the control group respectively. Body composition such as basal metabolism rate， fat free mass， lean body mass， total body water， fat mass， percentage of body fate， intracellular water， extracellular water of pregnant women was measured amongst 11-13， 17-20， 24-28， and 32-36 pregnant weeks； the measurement results of fasting blood-glucose （FPG） and oral glucose tolerance test （OGTT） respectively during document and 24 pregnant weeks were recorded； the changing characteristic of body composition in two groups in different pregnancy phase was analyzed and their relationship. Results The body composition outcome of control group was lower than that of GDM group while documention， 17-20 pregnant weeks and 24-28 pregnant weeks （P < 0.05 or P < 0.01）， but there were no statistical significance difference in 32-36 pregnant weeks （P > 0.05）. Compared with other gestational body composition index， the FPG in documention of patients in the GDM group had significant positive correlation with the basal metablic rate， content and percentage of body fat （r = 0.217， 0.255， 0.244， all P < 0.01）， the plasma glucose of fast after OGTT in 24 pregnant weeks had significant positive correlation with content and percentage of body fat at documention （r = 0.237， 0.239， all P < 0.01）， and one hour after glucose intake， level of blood glucose had significant positive correlation with 17-20 pregnant weeks （r = 0.302， 0.288， all P < 0.01）. Conclusion Matemal body composition index of the pregnant women with GDM is apparently higher than healthy pregnant， body fat increation in pregnancy is related to matemal glycemic excursion. The variation of matemal body composition may have some correlation with GDM occurrence.

[Key words] Gestational diabetes mellitus； Body composition； Bioelectrical impedance

妊娠期糖尿病（gestational diabetes mellitus，GDM）是妊娠期最常见的内科合并症之一，对母儿危害较大，越来越受到人们的重视。GDM孕妇体内的高糖环境及妊娠期特殊生理变化，将引起体脂含量、总体水、细胞外水等体成分发生不同程度的变化。本研究通过应用生物电阻抗技术，分析GDM孕妇在不同孕期母体成分与正常孕妇的差异，探讨体成分变化与GDM的相关性。

1 对象与方法

1.1 对象

选择2014年12月～2015年7月在中国人民解放军空军总医院（以下简称“我院”）建档的GDM孕妇77例为GDM组，纳入标准：①在我院产科建档，定期产检，孕期检查完善，基本信息完整。②建档时（孕11～13周）、孕17～20周、孕24～28周、孕32～36周完成体成分测定。……